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High body mass index and concomitant instabilities as risk factors for failure after acl revision surgery
Author(s):
Alm Lena (Germany)
,
Alm Lena (Germany)
Affiliations:
Krause M.
,
Krause M.
Affiliations:
Frosch K.
,
Frosch K.
Affiliations:
Akoto R.
Akoto R.
Affiliations:
ESSKA Academy. Alm L. May 9, 2018; 209397; P05-919 Topic: Sports Related Injuries
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Abstract
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Objectives: Revision surgery after primary anterior cruciate ligament (ACL) reconstruction occurs in 5 to 15%. Only a few low volume studies about failure after ACL revision surgery are available. Identifying risk factors for recurrent ACL graft failure is important to prevent reinjury and revision surgery.
We hypothesized that increased body mass index and insufficiently treated concomitant instabilities (medial collateral ligament, posterior oblique ligament, anterolateral ligament, etc.) will predict failure of acl revision surgery.

Methods: A total of 70 participants (mean age ± SD, 30.3 ± 4.5 years) who had undergone ACL revision surgery were included in the study. Clinical outcome was retrospectively evaluated at a mean follow up of 38.6 months (range 26 to 58). Failed acl revision reconstruction was defined as side-to-side difference greater than 5 mm and subjective instability. The evaluation also included subjective IKDC, Lysholm Score and Tegner Activity Score. Regression analyses was performed to identify risk factors for revision.

Results: Overall, 70 patients (33 women) underwent revision ACL surgery from 2013 to 2015. Recurrent instability after acl revision surgery occurred in 10 of 70 cases (14.3%). 37% (7/19) of patients with an increased bmi (>28 kg/m2) had failure of the revised acl graft whereas other patients (< 28 kg/m2) showed recurrent failure of the graft in 5.9% of the cases (3/51)(p=0,001). Analysis showed patients with increased body mass index ( >28 kg/m2) had greater risk of failure of the acl revision graft than other patients (< 28 kg/m2)(p=0,024). Also, patients with increased BMI ( >28 kg/m2) showed lower postoperative scores like IKDC (66.62 ±4.584), Lysholm (73.79± 3.653) and Tegner (5.07±1.657) in comparison to other patients (<28 kg/m2) (IKDC 77.42 ±3.456, p=0.043; Lysholm 79.88± 2.567, p=0.413; Tegner 6.12±1.676, p=0.050). An overall femoral tunnel malpositioning was detected in 36.8% of all cases preoperatively. All patients with failure after acl revision surgery (10/10) showed concomitant instabilities in postoperative examination whereas only 13.3% (8/60) of patients with stable acl revision graft showed further instabilities postoperatively (p=0,048).

Conclusions: Elevated failure rates of acl revision reconstruction occured when body mass index was increased (>28 kg/m2). When acl revision needs to be performed in these patients increased risk of failure can be predicted. Insufficiently treated concomitant instabilities seem to play a role in acl revision surgery.

Keywords:
acl revision surgery
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